AB0323 FACTORS ASSOCIATED TO CLINICAL INERTIA IN RHEUMATOID ARTHRITIS
Authors: S. Miladi, O. Boudrigua, A. Fazaa, H. Boussaa, L. Souabni, K. Ouenniche, S. Kassab, S. Chekili, K. Ben Abdelghani, A. Laatar
Journal: Annals of the Rheumatic Diseases (2022)

Background Clinical inertia in rheumatic diseases is defined as inability or undue delay to initiate or intensify therapy when the disease is active or de-escalate therapy when the disease is in remission. Understanding the various contributory factors to clinical inertia is helpful in ensuring appropriate planning to tackle the issue and achieving Treat-To-Target (T2T) goals. Objectives We aimed to identify medical therapeutic inertia in Rheumatoid Arthritis (RA) patients and to assess its contributing elements. Methods We conducted a monocentric study including 42 patients, fulfilling the 2010 ACR/EULAR classification criteria for RA, who consulted our outpatient department from november 2021 to January 2022. Study data collection included demographics, clinical and disease characteristics, and treatment history. The survey also contained the Satisfaction Questionnaire for Medication (TSQM) which provides validated score for four subscales: effectiveness, side effects, convenience, and global satisfaction. Treatment satisfaction was measured using a cutpoint global satisfaction score ≥ 80. Results Most patients were female (86%) with a mean age of 57±13 years and a mean disease duration of 10.8±4.7 years. The education level for most patients (62%) was secondary school education or less. Fifteen percent of patients were in full-time work, 27% were unemployed, and 54% were retired. RA impact on patients’ work-life was considerable, as 14.3% had retired early due to RA. Patients had moderate-to-high disease activity, with a mean DAS28 with C-reactive protein (CRP) of 4.2±1.4. Radiographic structural damage was apparent in 79% of patients. RA was immunopositive in 92% of patients. Most common comorbidities were cardiac disorders (32%), pulmonary disorders (13%), and metabolic/nutrition disorders (11%). Psychiatric disorders was present in 9.5% of patients. CsDMARDs were the most frequently prescribed medications, used in 69% cases, followed by bDMARDs used in 34% cases. A total of 54% received the anchor drug methotrexate as part of their treatment regime. Only 12% of patients used systemic glucocorticoids for RA. Only half (52%) of all patients had a planned switch of medication, despite long-standing disease and suboptimal symptom control with current DMARD therapy. Statistical analysis revealed that factors for switch decision to a different DMARD by the treating physician was: younger patient age (p=0.002), having a high disease activity by DAS28-ESR (p&lt;0.001), worse HAQ score (p&lt;0.001), lower global satisfaction score (p&lt;0.001), and patient preference for oral administration (p=0.006). Predictors for not switching to a different DMARD included a higher number of comorbidities (p&lt;0.001), lower current DAS28-ESR score (p&lt;0.001) and lower number of concomitant medications (p=0.002). Mean TSQM scores were 62 for effectiveness, 45 for side effects, 65 for convenience, and 60 for global satisfaction. Only 16 % of patients were satisfied with their RA treatment. Conclusion Our study showed that patients with active RA may not be managed in consistency with recommendations. This phenomenon defined as clinical inertia, is multi-factorial including healthcare set-ups and providers, patients and their caregivers. That’s why before labelling management of rheumatic disease in an individual as a ‘failure’, careful consideration of relevant factors linked to clinical inertia may be helpful. Disclosure of Interests None declared